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cavities are packed for 24 hours to prevent reformation. Should pus be
obtained on aspiration, and this is more usual, the swelling is incised, the
contents evacuated and a drain is left in place until drainage ceases. Such
patients should be given a course of antibiotics. This cures the condition
but in a percentage of cases there is a permanent depression of the cartilaginous
dorsum of the nose (Fig. 17) which, if severe, may require plastic correction to
restore the shape of the nose.
Fig. 17. Depression of the dorsum of the nose
following a septal abscess. {Reproduced by
permission of Bailliere Tindallfrom 'The
Ear, Nose and Throat Diseases of Children*,)
DEPRESSED NASAL BRIDGE
This deformity may affect the osseous bridge of the nose or the cartilaginous
part of the dorsum, and the deformity is sometimes called 'saddle nose'. It
is usually due to injury, often repeated injuries as in boxers, to a septal
abscess or to intranasal syphilis. The shape of the nose may be restored by a
rhinoplasty in which an inlay is introduced after correction of the bony
deformities.
CONGENITAL ATRESIA OF THE CHOANAE
This uncommon condition (Fig. 18) consists in the occlusion of the posterior
naris by a bony or membranous diaphragm due to the failure of the naso-
buccal or the buccopharyngeal membrane to absorb during fetal life. It is
usually unilateral, but bilateral cases occur and these are observed at birth as
the infant has the greatest difficulty in breathing, and the condition constitutes
a neonatal emergency. Because nasal breathing is normal the neonate strives
for breath while keeping the lips tightly closed. The accessory muscles of
respiration are used, the alae nasi dilate, and eventually the lips are sucked
inwards and part as cyanosis appears. A few gulping inspirations are taken